The Effectiveness of a Nano-Hydroxyapatite Paste and a Tri-Calcium Phosphate Fluoride Varnish in White Spot Lesions Remineralization (Randomized Clinical Trial)

Objective: To evaluate and compare clinically the effectiveness of a nano-hydroxyapatite (n-HAP) paste (Sesensibilize™ Nano-P, FGM) and a tri-calcium phosphate fluoride (TCP-F) varnish (Clinpro™ White Varnish, 3M ESPE) in remineralization of white spot lesions (WSLs) on young permanent teeth.
Methods: 20 patients having at least one pair of teeth with WSL were randomly selected to this study according to specific criteria. Each patient received two treatments of WSL; one treatment using n-HAP paste on one side of the arch (n-HAP group) and a second one using TCP-F varnish on the contralateral or opposing side of the arch (TCP-F group). A total of 80-teeth with WSLs were included in this randomized clinical trial. The reminaralizing agents were applied over the tooth surface with a WSL as per manufacturer recommendations. Four application sessions were completed during the first month on a weekly basis. DIAGNODENT PEN (DD) (Kavo Dental –Germany) was used to assess the degree of remineralization. DD readings were recorded at baseline, after one, three and six-months of the reminaralizing agents’ application. All patients attended the treatment sessions and remained throughout the follow-up periods.
Results: There was a statistically significant difference between the WSLs mean DD readings over time for both groups (Friedman, P<0.001). The mean DD reading was 22.05 (±3.250) in n-HAP group and 21.33 (±3.467) in TCP-F group at the baseline, decreased to 10.80 (±1.7423) and 9.675 (±2.693) at one-month, 8.30 (±1.880) and 10.95(±2.726) at the 3-month, 7.875 (± 1.555) and 13.725 (±2.745) at the 6-month follow-up in n-HAP group and TCP-F group respectively. Upon comparing the groups, the WSLs had a similar mean DD reading at baseline (P>0.05). There was no statistically significant difference in the mean DD reading at one-month between the two groups (P=0.032). However, the mean DD readings were significantly lower in the n-HAP group at 3- and 6-months with high statistical significant level (P <0.001).
Conclusion: The nano-hydroxyapatite paste (nano-P) and the tri-calcium phosphate varnish (clinpro) were effective in WSLs’ remineralization. Both treatment protocols could be advocated to promote remineralization of WSLs after orthodontic treatment. The nano-hydroxyapatite paste appears to demonstrate better stability than the tri-calcium phosphate varnish in its remineralization effect over the 6-month follow-up.